Posted by Brigham and Women's Hospital February 20, 2014

Open communication between patients and physicians can potentially lead to earlier diagnosis.

As a young primary care internist, Dr. Joseph Frolkis, Vice Chair of Primary Care in the Department of Medicine at Brigham and Women’s Hospital, routinely observed what he called the “Columbo phenomenon.”

Launched in the late 1960s, actor Peter Falk played a seemingly bumbling detective named Columbo in the TV show of the same name. At the end of each episode, Columbo would catch suspects off guard while on his way out the door, asking, “Just one more thing.”

In an article published in the Journal of the American Medical Association, Dr. Frolkis writes that the Columbo phenomenon in primary care illustrates a more benign yet important interaction between primary care physicians and their patients.

“Innumerable times in the span of my career, I have been at the door of the examination room, at the conclusion of the standard ‘15-minute visit,’ having dealt with the ostensible reason for the encounter (hypertension, diabetes, upper respiratory infection) when it is the patientwho says, ‘Doctor, just one more thing…’ It is then that I hear the actual reason for the visit: the rectal bleeding, the strange chest pain, the weird dizziness, the unusual shortness of breath. The patients in the waiting room notwithstanding, I turn back into the examination room, and the real work begins.”

Importance of Doctor-Patient Relationship

Dr. Frolkis notes that the relationship between primary care physicians (PCPs) and their patients remains ever-important. He observes that this unique relationship, based on trust, allows patients to feel comfortable discussing sensitive health issues, potentially leading to earlier diagnosis. It also can increase patients’ willingness to adhere to their medications or adopt healthier lifestyles.

“As physicians, active listening prompts patients to feel comfortable enough to share their concerns,” says Dr. Frolkis. “This skill can be taught to anyone who cares about people and wants to help them, not just doctors. Whenever any of us goes to the doctor’s office, we’re nervous, often anxious about the potential meaning of a symptom and maybe in pain. We want someone who makes eye contact, listens to us, and sits at our level. Over time, we get to know and trust them.”

Integrating Team-Based Care

Due to the current shortage of PCPs, the aging baby boomer population, and the shift to provide more care in the outpatient setting, physician teams are becoming more common in primary care. Yet even with the team-based model of care, relationships between physicians and patients will remain central to improving patient outcomes.

“The number of people over age 65 will double between now and 2030,” says Frolkis. “We have to continue to move toward teams providing great medical care, with patients seeing the appropriate member of that team for the problem at hand. This is happening both nationally and in all of our BWH primary care practices. Patient and provider satisfaction increases in the studies that have examined this model, and quality does, too. Patients can learn to trust all members of the team so that the power of the ‘Columbo phenomenon’ can be even further amplified, with outcomes rising accordingly. The bottom line? The care we provide our patients improves. That’s a goal we can all agree on.”